<div class="alert fade in">
    <h4>Masukkan No.KK Terlebih dahulu</h4>
</div>
<div class="row-fluid">
    <div class="span6">
        <div class="row-fluid">
            <div class="span12">
                <?php
                $dat = array(
                    'class' => 'form-horizontal'
                );
                echo form_open('petugas/nik_new', $dat);
                ?>
                <div class="control-group">
                    <label class="control-label" for="input01">No. KK</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan No. KK" id="kk" name="kk">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Nama</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Nama" id="nama" name="nama">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Tempat Lahir</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Tempat Lahir" id="tmpt" name="tmpt">
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Tanggal Lahir</label>
                    <div class="controls">
                        <div id="datepicker" class="hasDatepicker">
                            <input class="input-xlarge datepicker" type="text" placeholder="Masukkan Tanggal Lahir" id="tgl" name="tgl">
                        </div>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Jenis Kelamin</label>
                    <div class="controls">
                        <select class="span2" id="sex" name="sex">
                            <?php foreach ($sex as $df) : ?>
                                <option value="<?php echo $df->id ?>"><?php echo $df->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Gol Darah</label>
                    <div class="controls">
                        <select class="span2" id="darah" name="darah">
                            <?php foreach ($darah as $drh) : ?>
                                <option value="<?php echo $drh->id ?>"><?php echo $drh->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Agama</label>
                    <div class="controls">
                        <select class="span4" id="agama" name="agama">
                            <?php foreach ($agama as $agm) : ?>
                                <option value="<?php echo $agm->id ?>"><?php echo $agm->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Pendidikan Terakhir</label>
                    <div class="controls">
                        <select class="span8" id="pndkn" name="pndkn">
                            <?php foreach ($skul as $skl) : ?>
                                <option value="<?php echo $skl->id ?>"><?php echo $skl->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Pekerjaan</label>
                    <div class="controls">
                        <select class="span8" id="pkrjn" name="pkrjn">
                            <?php foreach ($gawe as $krj) : ?>
                                <option value="<?php echo $krj->id ?>"><?php echo $krj->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Penyandang Cacat</label>
                    <div class="controls">
                        <select class="span8" id="cct" name="cct">
                            <?php foreach ($cacat as $cct) : ?>
                                <option value="<?php echo $cct->id ?>"><?php echo $cct->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Status Perkawinan</label>
                    <div class="controls">
                        <select class="span8" id="kwn" name="kwn">
                            <?php foreach ($perkawinan as $kwn) : ?>
                                <option value="<?php echo $kwn->id ?>"><?php echo $kwn->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group">
                    <label class="control-label" for="input01">Status Hubungan Dalam Keluarga</label>
                    <div class="controls">
                        <select class="span8" id="hub" name="hub">
                            <?php foreach ($hubungan as $hbg) : ?>
                                <option value="<?php echo $hbg->id ?>"><?php echo $hbg->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
            </div>
        </div><!--/row-->
    </div><!--/span-->
    <div class="span6">
        <div class="row-fluid">
            <div class="span12">
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">NIK Ibu</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan NIK Ibu" id="nik_ib" name="nik_ib">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Nama Ibu</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Nama Ibu" id="nm_ib" name="nm_ib">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">NIK Ayah</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan NIK Ayah" id="nik_ay" name="nik_ay">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Nama Ayah</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Nama Ayah" id="nm_ay" name="nm_ay">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Anak Ke</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sebelumnya" id="anak" name="anak">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Alamat Sebelumnya</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sebelumnya" id="almt_lm" name="almt_lm">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Status Penduduk</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sekarang" id="sts_pndk" name="sts_pndk">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Surat Kelahiran</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sekarang" id="srt_lhr" name="srt_lhr">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Kewarganegaraan</label>
                    <div class="controls">
                        <select class="span3" id="warga" name="warga">
                            <?php foreach ($warga as $wrg) : ?>
                                <option value="<?php echo $wrg->id ?>"><?php echo $wrg->keterangan ?></option>
                            <?php endforeach; ?>
                        </select>
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Keterangan Pendidikan</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sekarang" id="ketpen" name="ketpen">
                    </div>
                </div>
                <div class="control-group form-horizontal">
                    <label class="control-label" for="input01">Foto</label>
                    <div class="controls">
                        <input class="input-xlarge" type="text" placeholder="Masukkan Alamat Sekarang" id="foto" name="foto">
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<div class="row-fluid">
    <div class="span4"></div>
    <div class="span4">
        <button class="btn btn-success" type="submit"><i class="icon-ok icon-white"></i> Simpan</button>
        <?php
        $danger = array(
            'class' => 'btn btn-inverse'
        );
        echo anchor('petugas/kk', 'Cancel', $danger)
        ?>
        <?php echo form_close(); ?>
    </div>
    <div class="span4"></div>
</div>